Telerehabilitation for motor function: a systematic review A Turolla 1, L Piron 1, T Gasparetto 2, M...
-
Upload
rosaline-sullivan -
Category
Documents
-
view
218 -
download
0
Transcript of Telerehabilitation for motor function: a systematic review A Turolla 1, L Piron 1, T Gasparetto 2, M...
Telerehabilitation for motor function:a systematic review
A Turolla1, L Piron1, T Gasparetto2, M Agostini1, HR Jorgensen3, P Tonin1, T Larsen4
1. Laboratory of Kinematics and Robotics, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice, Italy2. Social and Health Programs, Regione Veneto, Venice, Italy3. Sygheus Vendsyssel Brønderslev Neurorehabiliteringscenter. Brønderslev, Denmark4. Southern Denmark University, Centre for Applied Health Services Research and Technology Assessment
(CAST). Odense, Denmark
Background definitionTELEMEDICINE / TELECARE / TELEREHABILITATION
“…care given using telecommunications technologies, in which at least two communication media are used interactively (e.g. video consultation between hospital consultant and general practitioner).”
Implications for research in 2000
• Re-consider the focus and scope of telemedicine
• RCTs of telemedicine applications are feasible and should be carried out.
• Taking account of changes in distribution and use of telematics in society generally, not just in the health care context.
• Consider changing patterns of health care needs with emphasis on care for:– people with chronic conditions– the elderly– disease prevention– health promotion
• Patient-centred approaches.
• Studies of:– Effectiveness– Efficiency– Appropriateness
• Formal economic appraisal
Framework• FP7 - EU HEALTH:
INTEGRATED HOME CARE(grant n. 222954)
• Research for better ways to ensure continuity in clinical care for patients with chronic conditions:– Stroke– Heart failure– COPD
• WP 5 - Telerehabilitation
www.integratedhomecare.eu
Broad reviews’ search strategies
Inclusion criteria Exclusion criteria
1. Published in English
2. Populations:a) HF
b) COPD
c) STROKE
3. Age > 18 yrs
4. Home care setting in the intervention
5. Full-text articles in peer-reviewed journals
1. Reviews not addressing patients directly but caregivers or professionals
2. Reviews which did not address telemedicine in:
a) HF
b) COPD
c) STROKE
Flow chart of the selected reviews
InterventionTelemonitoring (HF, COPD)
• Telephone follow-up (TFU) • Interactive Health Communication Applications (IHCA) • Automated telemonitoring of vital signs and symptoms • Automated physiologic monitoring• Automated computer-based telephone messaging • Monitoring of patients carrying implanted electrical devices
Telerehabilitation (STROKE)
• Telephone follow-up (TFU) • Remote control and interaction with devices based on position/sensing
technologies• Remote control and interaction with virtual reality based devices
Evidences(4 metanalysis)
HF HF & COPD HF & STROKE
•Telemonitoring reduces:–mortality (RR=0.65, p=0.03)–hospital readmission (21%)
•Poor reporting:–costs–adherence–acceptability
•Interactive Health Communication Applications improves:
–Knowledge–Social support–Clinical outcomes
•Case management interventions reduce mortality (OR=0.68, p=0.04)
•TFU patients show clinically-equivalent results compared to control groups, due to the low methodological quality of the studies
ConclusionsIn stroke patients, should be preferred an on-line interactive device (allowing
also videoconference) than a store and forward device to provide telerehabilitation.
Hard primary outcomes like:• overall mortality• hospital admissionshould also be included to prove efficacy.
Secondary outcomes like:• QoL,• costs,• adherence to treatment• patient acceptabilityshould be taken into consideration to perform a complete analysis of
telerehabilitation.
How much broad or narrow should be a
systematic review on telerehabilitation?
Research methods
• PubMed = 964 records
• EMBASE = 328 records
• The Cochrane Library – CENTRAL=113 records
Inclusion criteria
InterventionTele-based therapy programs defined as:1. provided by means of any kind of technological
device which should allow a healthcare professionals/patient on-line interaction;
2. provided by healthcare professionals or individuals under the supervision of healthcare professionals;
3. including at least one or more than one specific intervention targeted to motor function.
Inclusion criteria
Type of studies• RCTs• qRCTs• CCT• First phase of cross over trial
Inclusion criteria
Comparison
• Tele-based therapy programs vs. placebo or no intervention
• Tele-based therapy prograse vs usual care
• Tele-based therapy programs vs in-presence care
Outcome
• Motor function
Quality assessment
Items:1. generation of randomization sequence;2. allocation concealment;3. baseline comparison between groups;4. blinding of outcome assessors;5. intention-to-treat analysis;6. type of study.
Flowchart of the publications’ selection process
Potentially relevant studies identified and screened for retrieval (n=1405)
Duplicates (n=199)
Studies retrieved (n=1207)
Studies included in the metanalysis (n=9)
Not meeting inclusion criteria (n=1197)
Quality assessment
Randomization
sequence allocation
concealment
baseline comparison
between groups
blinding of outcome
assessors
ITT
Analysistype of study
Barnason 2009 × × √ × × √Furber 2010 √ √ √ √ × √Hermes 2007 √ √ √ × × √Huijen 2008 √ √ √ × × √Russell, 2011 √ √ √ √ √ √Piron 2008 √ √ √ × × √Piron 2009 √ √ √ × × √Dall'Olio, 2008 √ √ √ √ × √Tousignat, 2010 √ √ √ √ × √
Treated populations
trials/population
0
1
2
3
4
5
6
Neurological Post surgery Heart Failure
trial
Treated patients
patients/population
168150
97
126 166
107
0
50
100
150
200
250
300
350
Neurological Post surgery Heart Failure
CTRL
EXP
Telerehabilitation vs usual careOutcome: Motor function
Telerehabilitation vs usual careOutcome: Motor function
Conclusions• Little but no significant benefit of telerehabilitation compared
to usual care (0.1 SD)
• If measured, others advantages could sustain the use of telerehabilitation:– Costs– Accessibility– Acceptability
• A low number of authors have published in the field No random distribution of bias in different studies
• Trial sequence analysis STOP randomization?
“You can discover more about a person in a hour of play, than in a life of conversation”
Plato
Thanks for your attention!
San Marco square looking southeast (1735-40)Gian Antonio Canal called “Canaletto”